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Evidence Based Ayurveda in reality
DR.REMYA KRISHNAN MD(AY) PHD
ASSOCIATE PROFESSOR & HOD
DEPARTMENT OF DRAVYAGUNA, RGAMC , MAHE.
FACTS, SOLUTIONS AND DIRECTIONS
              FOR:


             Would be Doctors
             Doctors who are just
             starting out their career.
             Doctors who are in the
             thick of Medical practise.
             Doctors who are at the
             sharp end of difficult decision
             in the clinic.
AIM OF THE BOOK
• To enable the physician to enjoy his patients .
• To enable the physician to practise “Science
  based Medicine” instead of “Medicine based
  Science”.
• To inspire a Medical student/House surgeon/
  Doctor of any age “to constantly inspire
  himself” to do the best in the Science for the
  patient .
WHAT THE BOOK SPEAKS
• Ayurvedic evidence?! How can we best find it,
  interpret it, and contribute to it?
• The crucial role of Basic science of Ayurveda
  in its evidence structure.
• How can we sort of ways for which we can
  think of and apply evidence in our practise
  and research?
• “How” to choose an Evidence Based medicine
  (More important than what to choose )
OBJECTIVE OF THE BOOK

• Exercise judgement on the best estimates of
  diagnosis, prognosis , cure and prevention.
• Accurately project the scientificity of this
  Medical system .
• World wide recognition of what is called
  EVIDENCE BASED AYURVEDA.
WHAT IS THIS “EVIDENCE” ???
• Evidence simply means proof .
• Evidence is required for the “SCIENCE
  FORWARDED MEDICINE” and not for the
  “Medicine forwarded Science”
• Evidence (Proven Science) behind ,the medicine
  originally determines the strength of proof of a
  medicine .
• Medicine forwarded science starts from an
  “unknown compound for an unknown disease“
  and hence is not necessarily proven.
PROVEN MEDICINE
Proven Medicine DOES NOT MEAN Proven
Medical Science.
Proven Medical Science can only narrate
ETERNALLY PROVEN MEDICINES .
Proven Medicine with no proven science
behind makes it “UNCERTAIN medicine”.
Proven Medicine with no proven science
behind is INVALID PROOF.
MEDICAL EVIDENCE TODAY
The current medical research is focussed
on “medicine” and not on “Science”

The core of current research evidence is
Randomised Control Study and Probability
based Statistics .

 Probability Based Evidence - Physician’s
detachment from the dynamic principles
of Basic science which best explains the
nature of patient and disease.
Medical(Mechanical)evidence




Understanding - The physician is made deprived
of “Science based reasoning .
Wisdom – The physician is not allowed to apply
wisdom .
What is lacking ??
             DISSATISFIED DOCTOR




•   Medicine not led by Proven Science can turn harmful in any moment.
•   The medicine is applied based on “Statistics” and not “ Science”.
•   Today’s medicine can turn out to be tomorrow’s venom
•   MODERNITY DOES NOT NECESSARILY MEAN VALIDITY OF MEDICINE
Is today’s EBM “evident”??

 Today’s EBM is not the real EBM .
 In true EBM, Evidence (Proven
 Science) must lead the Applied
 Medicine .
In current EBM , ‘Medicine
based proof ’ is leading the
Applied Medicine .
Today’s EBM is originally
just MBE ( Medicine
Based Evidence)
A comparison of evidence
Modern Medicine (MBE)        Ayurveda (EBM)
Evidence resources are       Evidence resources are
published DRUG reports and   published and peer reviewed
journal articles (Pubmed/    LIFE SCIENCE theorems &
Medline)                     principles to guide Applied
                             Medicine
Applied Research Evidence     Basic research Evidence
Medicine Based               Evidence Based Medicine
Evidences(MBE)               (EBM)
Temporarily valid            Permananantly valid
Ayurveda –Evidence Based??
     Ayurveda- EBM or MBE ?

“tt: kmR iw8k pXcat )anpUvR. smacret|
“tt: kmR iw8k pXcat )anpUvR. smacret|
 )animit AaPtopdexm“
  )animit AaPtopdexm“


“ “ svR4a svRmaloCy y4a sMwvm4Rivt|
 svR4a svRmaloCy y4a sMwvm4Rivt|
A4a@yvSyet tTve cckayeR cctdnNtrm||“
 A4a@yvSyet tTve kayeR tdnNtrm||“
 EVIDENCE (TATWA)   APPLIED MEDICINE(KARYA)
)ansmudaye pUvRmaPtopdex)anm||
Evidence Based Ayurveda

Evidence Based Ayurveda is Ayurvedic
Medical decision making and action based on
systematic scientific critical appraisal of Basic
Science( Ayurvedic) Evidences in patient
health care .
Present scenario
• Poorly recognised by the majority of
  physicians of Ayurveda in India .
• No specific knowledge regarding EBA to
  medical students and physicians .
• Absence of EBA Physicians provides little
  stimulus for the development of specific
  protocols of EBA .
Bruhathrayees




• Imperative resource for medical decision making .
• Evidences formed after scientific evaluation and best peer
  reviewed for over centuries.
• Evidences based on “ Basic science of human life ”.
• Evidences deemed safest and effective by unbiased scientists .
• Evidences which aptly guide Applied Medicine .
VALIDITY

The most scientific theories do not change in
 their fundamental understanding.
 No amendment possible means “truly
 scientific” .
Could be best simplified and applied on
 target.
Five fold evidences in Ayurveda
 Scientific Principles
• Roga tatwas- Disease oriented principles
• Rogi tatwas- Patient oriented principles
• Bheshaja tatwas- Treatment Principles
• Kaala tatwas – State and stage (disease and
  patient) oriented principles
• Phala tatwas- Effect determinant principles
Current Ayurvedic research

•    Disconnected from basic science.
•   Deviated from Five- fold evidences.
•   Absence of scientific reasoning (Tarka).
•   Probability based statistics.
•   Unscientific Double blind studies and Placebo
    control
What to re-search?

Appraisal of Evidence
 Application of Evidence.
Optimization of Evidence in new health care
 requirements .
 Science based Quality control of Ayurvedic
 drugs & formulations.
Current problem in Ayurveda

 Ignorance of Evidence Based Medicine

  Blind hunt of Medicine Based Evidence
The Drug action is unpredictable
 without Evidence Based Medicine .
Medicine Based Evidence

      Conflicting opinions
      Misinterpretation of
      research outcome by
      Modern scientific
      parameters.
      Research outcome mostly
      benefit Modern Medicine.
      Research outcome
      immaterial to Ayurveda
WHAT DO WE LACK??

WE HAVE STABLE EVIDENCE OF BASIC RESEARCH

 WE LACK : APPRAISAL OF EVIDENCE
            APLICATION OF EVIDENCE

 INFACT IT IS’’ WE ‘’WHO ARE LACKING , NOT
  OUR SCIENCE
EVIDENCE APPRAISAL

 Evidence appraisal refers to the process of
 systematised examination and analysis of Five
 fold evidence to evolve scientific standards from
 them relevant to the medical context to
 streamline the therapeutics for attaining
 effectiveness of therapies
 A Novel scientific technique for appraisal of
 evidences are mentioned for the first time in
 Ayurveda in this book known as EVIDENCE TRIAD
 APPROACH (ETA)
WHY EVIDENCE APPRAISAL?!

• Trains you for “on the target prescribing”.
• Transforms you into a true “Bhishak”.
• Enables you to choose the simplest & best
  Evidence Based intervention for your patient.
• Minimises the number of drugs in your
  prescription just to one or two.
When EBA is practised
      No separate logic of treatment
      for each specialist.
      Each specialist would be the best
      Doctor integrator of various
      systemic pathologies.
      Diagnosis of one integral disease
      behind multiple symptoms is
      possible.
       Implementation of the best
      appropriate evidence .
Why do we mimic Modern Medicine?




               Obsessed by Western
               charm
                Ignorance .
               Misunderstanding.
               Diffidence .
               Excessive commercial
               interest.
Only Solution
• TRAINING& WORKSHOPS ON PRACTISE OF
  EVIDENCE BASED AYURVEDA.
• ALL IDEAS ARE USELESS UNLESS WE APPLY
  THEM .
• THIS BOOK INCORORATES SOME BEST
  PRACTICAL SOLUTIONS .
• THIS BOOK INCORPORATES SIMPLE AND
  DIRECT STEPS FOR GUIDANCE IN PRACTISE OF
  EBA.
Finding Evidence-Based Answers to Clinical Questions
I need                Example              Evidence resources to
                                           consider

                      How to evolve the Five fold Evidence
 An overview of a     pathogenesis of
particular disease,   Dengue fever in
condition or          Ayurvedic terms?
background            I have a Dengue
information           suspicious patient ,
                      hence need an
                      immediate overview
                      of the condition
Drug action           Which Treatment      Five fold evidence
                      Principle is
                      appropriate for my
                      patient with HTN?
Finding Evidence-Based Answers to Clinical Questions

 Best recommendations What is the best Treatment            Five fold
            for disease Principle for my patient with       evidence
          management DUB ? How to decipher the
                        patient particular samprapti in
                        Ayurveda?
To solve confusions :    Why does Amrutharishta fail to     Five fold
                         check fever in my patient?         evidence
                         What should I understand when
                         my patient’s joint pain shoot up
                         after Sneha sweda??
                         What specific Pathya should I       Five fold
Information to share     suggest to my patient ?            evidence
with patients            What Apathya should I ask him
                         to avoid ?
ART OF PRESCRIBING




                         Abandon This medicine –
                         That disease Approach.

Adopt Treatment Principle (Evidence) based
Clinical Practise & Research .
Medicine Based Prescribing

Unscientific
Unpredictable



Dangerous
Destructive
Why not Evidence Based Ayurveda?????


                             Commercial gain


          EBA           “HEALTH FOR ALL”

                         World wide acceptance
Today, world is not accepting Ayurveda, only
because it is practiced ‘Medicine Based’ and not
‘Evidence Based’
EVIDENCE BASED AYURVEDA




      Why not practise
      EBA??
Modern Medicine –PROBABILITY BASED



Modern Medicine is
only MEDICINE
BASED EVIDENCE .
SALIENT FEATURES OF
            BOOK“EBA&RP”
• ENABLES YOU TO KNOW AND PRACTISE EVIDENCE
  BASED AYURVEDA .
• INCORPORATES NEW TECHNIQUES ON HOW TO
  MAKE THE BEST USE OF OUR EVIDENCES .
• EMPHASIS ON HOW TO DEAL WITH THE COMMON
  CONFUSIONS IN MEDICAL DECISION MAKING.
• GREATER COVERAGE OF APPLIED ASPECTS IN
  MEDICINE
• MAKE US COMPETENT AND CONFIDENT IN OUR
  CAREER
Conclusion

 Let us stop living in science as if we are asleep !!

 Let us ponder into our Basic Science and streamline
 evidence by their organized application!

 Let us recognize and practise Evidence Based
  Medicine !
 Let us adopt the best scientific ways to serve the
  mankind!
ATTENTION PLEASE!


 ONLY WE CAN PRACTISE
 EVIDENCE BASED MEDICINE
 IN REALITY

LET US SHOW THE WORLD
THE WORLD
THE STRENGTH OF
EVIDENCE BASED AYURVEDA
xuw. wUyat....Have a GREAT Year
            Ahead!

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Eba

  • 1. Evidence Based Ayurveda in reality DR.REMYA KRISHNAN MD(AY) PHD ASSOCIATE PROFESSOR & HOD DEPARTMENT OF DRAVYAGUNA, RGAMC , MAHE.
  • 2. FACTS, SOLUTIONS AND DIRECTIONS FOR: Would be Doctors Doctors who are just starting out their career. Doctors who are in the thick of Medical practise. Doctors who are at the sharp end of difficult decision in the clinic.
  • 3. AIM OF THE BOOK • To enable the physician to enjoy his patients . • To enable the physician to practise “Science based Medicine” instead of “Medicine based Science”. • To inspire a Medical student/House surgeon/ Doctor of any age “to constantly inspire himself” to do the best in the Science for the patient .
  • 4. WHAT THE BOOK SPEAKS • Ayurvedic evidence?! How can we best find it, interpret it, and contribute to it? • The crucial role of Basic science of Ayurveda in its evidence structure. • How can we sort of ways for which we can think of and apply evidence in our practise and research? • “How” to choose an Evidence Based medicine (More important than what to choose )
  • 5. OBJECTIVE OF THE BOOK • Exercise judgement on the best estimates of diagnosis, prognosis , cure and prevention. • Accurately project the scientificity of this Medical system . • World wide recognition of what is called EVIDENCE BASED AYURVEDA.
  • 6. WHAT IS THIS “EVIDENCE” ??? • Evidence simply means proof . • Evidence is required for the “SCIENCE FORWARDED MEDICINE” and not for the “Medicine forwarded Science” • Evidence (Proven Science) behind ,the medicine originally determines the strength of proof of a medicine . • Medicine forwarded science starts from an “unknown compound for an unknown disease“ and hence is not necessarily proven.
  • 7. PROVEN MEDICINE Proven Medicine DOES NOT MEAN Proven Medical Science. Proven Medical Science can only narrate ETERNALLY PROVEN MEDICINES . Proven Medicine with no proven science behind makes it “UNCERTAIN medicine”. Proven Medicine with no proven science behind is INVALID PROOF.
  • 8. MEDICAL EVIDENCE TODAY The current medical research is focussed on “medicine” and not on “Science” The core of current research evidence is Randomised Control Study and Probability based Statistics .  Probability Based Evidence - Physician’s detachment from the dynamic principles of Basic science which best explains the nature of patient and disease.
  • 9. Medical(Mechanical)evidence Understanding - The physician is made deprived of “Science based reasoning . Wisdom – The physician is not allowed to apply wisdom .
  • 10. What is lacking ?? DISSATISFIED DOCTOR • Medicine not led by Proven Science can turn harmful in any moment. • The medicine is applied based on “Statistics” and not “ Science”. • Today’s medicine can turn out to be tomorrow’s venom • MODERNITY DOES NOT NECESSARILY MEAN VALIDITY OF MEDICINE
  • 11. Is today’s EBM “evident”?? Today’s EBM is not the real EBM . In true EBM, Evidence (Proven Science) must lead the Applied Medicine . In current EBM , ‘Medicine based proof ’ is leading the Applied Medicine . Today’s EBM is originally just MBE ( Medicine Based Evidence)
  • 12. A comparison of evidence Modern Medicine (MBE) Ayurveda (EBM) Evidence resources are Evidence resources are published DRUG reports and published and peer reviewed journal articles (Pubmed/ LIFE SCIENCE theorems & Medline) principles to guide Applied Medicine Applied Research Evidence Basic research Evidence Medicine Based Evidence Based Medicine Evidences(MBE) (EBM) Temporarily valid Permananantly valid
  • 13. Ayurveda –Evidence Based?? Ayurveda- EBM or MBE ? “tt: kmR iw8k pXcat )anpUvR. smacret| “tt: kmR iw8k pXcat )anpUvR. smacret| )animit AaPtopdexm“ )animit AaPtopdexm“ “ “ svR4a svRmaloCy y4a sMwvm4Rivt| svR4a svRmaloCy y4a sMwvm4Rivt| A4a@yvSyet tTve cckayeR cctdnNtrm||“ A4a@yvSyet tTve kayeR tdnNtrm||“ EVIDENCE (TATWA) APPLIED MEDICINE(KARYA) )ansmudaye pUvRmaPtopdex)anm||
  • 14. Evidence Based Ayurveda Evidence Based Ayurveda is Ayurvedic Medical decision making and action based on systematic scientific critical appraisal of Basic Science( Ayurvedic) Evidences in patient health care .
  • 15. Present scenario • Poorly recognised by the majority of physicians of Ayurveda in India . • No specific knowledge regarding EBA to medical students and physicians . • Absence of EBA Physicians provides little stimulus for the development of specific protocols of EBA .
  • 16. Bruhathrayees • Imperative resource for medical decision making . • Evidences formed after scientific evaluation and best peer reviewed for over centuries. • Evidences based on “ Basic science of human life ”. • Evidences deemed safest and effective by unbiased scientists . • Evidences which aptly guide Applied Medicine .
  • 17. VALIDITY The most scientific theories do not change in their fundamental understanding.  No amendment possible means “truly scientific” . Could be best simplified and applied on target.
  • 18. Five fold evidences in Ayurveda Scientific Principles • Roga tatwas- Disease oriented principles • Rogi tatwas- Patient oriented principles • Bheshaja tatwas- Treatment Principles • Kaala tatwas – State and stage (disease and patient) oriented principles • Phala tatwas- Effect determinant principles
  • 19. Current Ayurvedic research • Disconnected from basic science. • Deviated from Five- fold evidences. • Absence of scientific reasoning (Tarka). • Probability based statistics. • Unscientific Double blind studies and Placebo control
  • 20. What to re-search? Appraisal of Evidence  Application of Evidence. Optimization of Evidence in new health care requirements .  Science based Quality control of Ayurvedic drugs & formulations.
  • 21. Current problem in Ayurveda Ignorance of Evidence Based Medicine Blind hunt of Medicine Based Evidence The Drug action is unpredictable without Evidence Based Medicine .
  • 22. Medicine Based Evidence Conflicting opinions Misinterpretation of research outcome by Modern scientific parameters. Research outcome mostly benefit Modern Medicine. Research outcome immaterial to Ayurveda
  • 23. WHAT DO WE LACK?? WE HAVE STABLE EVIDENCE OF BASIC RESEARCH  WE LACK : APPRAISAL OF EVIDENCE APLICATION OF EVIDENCE  INFACT IT IS’’ WE ‘’WHO ARE LACKING , NOT OUR SCIENCE
  • 24. EVIDENCE APPRAISAL  Evidence appraisal refers to the process of systematised examination and analysis of Five fold evidence to evolve scientific standards from them relevant to the medical context to streamline the therapeutics for attaining effectiveness of therapies A Novel scientific technique for appraisal of evidences are mentioned for the first time in Ayurveda in this book known as EVIDENCE TRIAD APPROACH (ETA)
  • 25. WHY EVIDENCE APPRAISAL?! • Trains you for “on the target prescribing”. • Transforms you into a true “Bhishak”. • Enables you to choose the simplest & best Evidence Based intervention for your patient. • Minimises the number of drugs in your prescription just to one or two.
  • 26. When EBA is practised No separate logic of treatment for each specialist. Each specialist would be the best Doctor integrator of various systemic pathologies. Diagnosis of one integral disease behind multiple symptoms is possible. Implementation of the best appropriate evidence .
  • 27. Why do we mimic Modern Medicine? Obsessed by Western charm  Ignorance . Misunderstanding. Diffidence . Excessive commercial interest.
  • 28. Only Solution • TRAINING& WORKSHOPS ON PRACTISE OF EVIDENCE BASED AYURVEDA. • ALL IDEAS ARE USELESS UNLESS WE APPLY THEM . • THIS BOOK INCORORATES SOME BEST PRACTICAL SOLUTIONS . • THIS BOOK INCORPORATES SIMPLE AND DIRECT STEPS FOR GUIDANCE IN PRACTISE OF EBA.
  • 29. Finding Evidence-Based Answers to Clinical Questions I need Example Evidence resources to consider How to evolve the Five fold Evidence An overview of a pathogenesis of particular disease, Dengue fever in condition or Ayurvedic terms? background I have a Dengue information suspicious patient , hence need an immediate overview of the condition Drug action Which Treatment Five fold evidence Principle is appropriate for my patient with HTN?
  • 30. Finding Evidence-Based Answers to Clinical Questions Best recommendations What is the best Treatment Five fold for disease Principle for my patient with evidence management DUB ? How to decipher the patient particular samprapti in Ayurveda? To solve confusions : Why does Amrutharishta fail to Five fold check fever in my patient? evidence What should I understand when my patient’s joint pain shoot up after Sneha sweda?? What specific Pathya should I Five fold Information to share suggest to my patient ? evidence with patients What Apathya should I ask him to avoid ?
  • 31. ART OF PRESCRIBING Abandon This medicine – That disease Approach. Adopt Treatment Principle (Evidence) based Clinical Practise & Research .
  • 33. Why not Evidence Based Ayurveda????? Commercial gain EBA “HEALTH FOR ALL” World wide acceptance Today, world is not accepting Ayurveda, only because it is practiced ‘Medicine Based’ and not ‘Evidence Based’
  • 34. EVIDENCE BASED AYURVEDA Why not practise EBA??
  • 35. Modern Medicine –PROBABILITY BASED Modern Medicine is only MEDICINE BASED EVIDENCE .
  • 36. SALIENT FEATURES OF BOOK“EBA&RP” • ENABLES YOU TO KNOW AND PRACTISE EVIDENCE BASED AYURVEDA . • INCORPORATES NEW TECHNIQUES ON HOW TO MAKE THE BEST USE OF OUR EVIDENCES . • EMPHASIS ON HOW TO DEAL WITH THE COMMON CONFUSIONS IN MEDICAL DECISION MAKING. • GREATER COVERAGE OF APPLIED ASPECTS IN MEDICINE • MAKE US COMPETENT AND CONFIDENT IN OUR CAREER
  • 37. Conclusion  Let us stop living in science as if we are asleep !!  Let us ponder into our Basic Science and streamline evidence by their organized application!  Let us recognize and practise Evidence Based Medicine !  Let us adopt the best scientific ways to serve the mankind!
  • 38. ATTENTION PLEASE! ONLY WE CAN PRACTISE EVIDENCE BASED MEDICINE IN REALITY LET US SHOW THE WORLD THE WORLD THE STRENGTH OF EVIDENCE BASED AYURVEDA
  • 39. xuw. wUyat....Have a GREAT Year Ahead!